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American Journal of Ophthalmology [journal]
- Stereopsis Results at 4.5 Years of Age in the Infant Aphakia Treatment Study. [JOURNAL ARTICLE]
- Am J Ophthalmol 2014 Sep 23.
To determine whether stereopsis of infants treated for monocular cataracts varies with the type of optical correction used .Randomized prospective clinical trial METHODS: The Infant Aphakia Treatment Study randomized 114 patients with unilateral cataracts at age 1 to 7 months to either primary intraocular lens (IOL) or contact lens correction. At 4.5 years of age a masked examiner assessed stereopsis on these patients using three different tests: 1) Frisby; 2) Randot Preschool; and 3) Titmus fly.Twenty-eight patients (25%) had a positive response to at least one of the stereopsis tests. There was no statistically significant difference in stereopsis between the two treatment groups. Frisby (contact lens, 6 (11%); IOL, 7 (13%); p=0.99), Randot (contact lens, 3 (6%) ;IOL, 1 ( 2%); p=0.62) or Titmus: (contact lens, 8 (15%); IOL, 13 (23%); p=0.34). The median age at surgery for patients with stereopsis was younger than for those without stereopsis (1.2 versus 2.4 months; p=0.002). The median visual acuity for patients with stereopsis was better than for those without stereopsis (20/40 vs. 20/252; p=0.0003).The type of optical correction did not influence stereopsis outcomes. However, two other factors did: age at surgery and visual acuity in the treated eye at age 4.5 years. Early surgery for unilateral congenital cataract and the presence of visual acuity better than or equal to 20/40 appear to be more important than the type of initial optical correction used for the development of stereopsis. Trial Registration clinicaltrials.gov Identifier NCT00212134.
- Reproducibility of Retinal Nerve Fiber Layer Thickness Measures Using Eye-Tracking with Spectral-Domain Optical Coherence Tomography in Children with Non-Glaucomatous Optic Neuropathy. [JOURNAL ARTICLE]
- Am J Ophthalmol 2014 Sep 22.
To determine the intra- and intervisit reproducibility of circumpapillary retinal nerve fiber layer (RNFL) thickness measures using eye-tracking assisted spectral domain optical coherence tomography (SD-OCT) in children with nonglaucomatous optic neuropathy.Prospective longitudinal study METHODS: Circumpapillary RNFL thickness measures were acquired with the Spectralis (Heidelberg Engineering) SD-OCT using the eye-tracking feature at two separate study visits. Children with normal and abnormal vision (visual acuity ≥ 0.2 logMAR above normal and or visual field loss) who demonstrated clinical and radiographic stability were enrolled. Intra- and intervisit reproducibility was calculated for the global average and 9 anatomic sectors by calculating the coefficient of variation and intraclass correlation coefficient.Forty-two subjects (median age 8.6 years, range 3.9 -18.2 years) met inclusion criteria and contributed 62 study eyes. Both the abnormal and normal vision cohort demonstrated the lowest intravisit coefficient of variation for the global RNFL thickness. Intervisit reproducibility remained good for those with normal and abnormal vision, although small but statistically significant increases in the coefficient of variation were observed for multiple anatomic sectors in both cohorts. The magnitude of visual acuity loss was significantly associated with the global (β = 0.026, P < .01) and temporal sector coefficient of variation (β = 0.099, P < .01).SD-OCT with eye tracking demonstrates highly reproducible RNFL thickness measures. Subjects with vision loss demonstrate greater intra- and intervisit variability than those with normal vision.
- Heidelberg Spectralis Ultra-widefield Fundus Fluorescein Angiography in Infants. [JOURNAL ARTICLE]
- Am J Ophthalmol 2014 Sep 20.
To describe the intraoperative use of the Heidelberg Spectralis for ultra-widefield fundus fluorescein angiography in infants.Retrospective observational case series.A modified Heidelberg Spectralis was used to perform ultra-widefield fundus fluorescein angiography in infants undergoing an examination under general anesthesia for a range of retinal vasculopathies. Peripheral angiographic findings, angiographic image acquisition time, and any complications were reviewed.A total of 22 eyes of 11 infants underwent intraoperative ultra-widefield fundus fluorescein angiography using the modified Heidelberg Spectralis. Ultra-widefield fundus fluorescein angiography was successfully performed in all infants and permitted capture of the posterior pole as well as the peripheral retina in a single shot centered on the macula. Peripheral retinal pathologies captured include neovascularization, capillary non-perfusion, and skip areas from previous laser treatment. Capturing of angiographic images took a mean time of 7.09 minutes. Image artifact from condensation of the ultra-widefield lens was noted during imaging of one infant.The modified Heidelberg Spectralis is an effective and reliable imaging tool for performing ultra-widefield fundus fluorescein angiography in infants. It is capable of capturing wide-angle images of high quality. The technique has advantages as an alternative to RetCam fluorescein angiography in infants undergoing an examination under general anesthesia.
- The corneal ulcer one-touch study: a simplified microbiological specimen collection method. [JOURNAL ARTICLE]
- Am J Ophthalmol 2014 Sep 19.
To determine if a new, single-sample device (ESwab) can simplify the traditional multi-sample approach to specimen collection in infectious keratitis.Prospective, diagnostic test evaluation.In this institutional study, patients with suspected infectious keratitis meeting traditional criteria for diagnostic corneal specimen collection and culture were randomized to the order of first specimen collection method: ESwab or a sample directly plated for growth on chocolate agar. This was followed by standard samples for blood agar, Gram stain, Sabauraud's agar, thioglycolate broth, and brain heart infusion broth in all cases. The specimens collected using the two approaches were analyzed separately by the laboratory in a blinded fashion. The main outcome measure was positive growth on cultured media.81 eyes from 80 consecutive patients were sampled. Culture positivity rate for the multi-sample method and ESwab was 70% and 69%, respectively, with a 75% agreement rate. ESwab sensitivity was 84% (95% confidence interval [CI]: 72-93%), with a specificity of 67% (95% CI: 45-84%). Positive and negative predictive values of the ESwab were 86% (95% CI: 74-94%) and 64% (95% CI: 43-82%), respectively. There was no difference in positive culture reports with respect to the order of specimen collection technique used.The single-sample ESwab method is a more accessible and less cumbersome approach to corneal culturing for ophthalmologists, particularly those in the community setting who do not have access to the full set of traditional culture materials. Culture results using this single sample approach were comparable to the multi-sample method.
- The Spectrum of Superficial and Deep Capillary Ischemia in Retinal Artery Occlusion. [JOURNAL ARTICLE]
- Am J Ophthalmol 2014 Sep 22.
To describe the spectrum of retinal capillary ischemia, including superficial and deep capillary ischemia, as identified with spectral-domain optical coherence tomography (SD-OCT) that occurs in retinal arterial occlusive disease.Retrospective observational case series METHODS: Clinical charts, color fundus photography, red-free fundus photography, fluorescein angiography, near-infrared reflectance and SD-OCT imaging in 40 eyes of 35 patients with retinal arterial occlusive disease were studied in both the acute and chronic phases in multicenter clinical practices. SD-OCT imaging analysis was employed to characterize the presence of superficial and deep capillary ischemia in each eye.Of the 40 eyes, 15 eyes had central retinal artery occlusion (CRAO), 22 eyes had branch retinal artery occlusion (BRAO) and 3 eyes had cilioretinal artery occlusion. During the acute phase, SD-OCT showed the following 3 distinct patterns, related to retinal ischemia occurring at varying levels within the retina: 1. Thickening and hyper-reflectivity of the inner retinal layers, including the nerve fiber and ganglion cell layers due to ischemia of the superficial capillary plexus; 2. A hyper-reflective band at the level of the inner nuclear layer, termed "paracentral acute middle maculopathy" representing ischemia of the intermediate and deep retinal capillary plexuses (deep capillary ischemia); and 3. Diffuse thickening and hyper-reflectivity of both the inner and middle retinal layers, which represented both superficial and deep capillary ischemia. Of all eyes, 31 (78%) had both superficial and deep lesions. The remaining 9 (22%) eyes had isolated deep capillary ischemia producing paracentral acute middle maculopathy with sparing of the superficial capillary plexus and a normal fluorescein angiographic appearance. As the lesions evolved into the chronic phase over the ensuing 3 months, the resultant thinning and atrophy reflected the retinal layers affected during the acute phase.SD-OCT imaging reveals the spectrum of capillary ischemia in retinal artery occlusive disease showing variable involvement of the superficial and intermediate/deep capillary plexuses. Isolated deep capillary ischemia manifested as paracentral acute middle maculopathy on SD-OCT and may be seen in some eyes with retinal arterial circulation compromise despite complete absence of perfusion abnormalities on fluorescein angiography.
- Choroidal Findings in Dome-Shaped Macula in Highly Myopic Eyes: a longitudinal study. [JOURNAL ARTICLE]
- Am J Ophthalmol 2014 Sep 19.
To describe choroidal findings in dome-shaped macula associated with high myopia using fluorescein angiography (FA), indocyanine green angiography (ICGA), and spectral-domain optical coherence tomography (SD-OCT), and to elucidate the mechanism and natural course of serous retinal detachment (RD) associated with dome-shaped macula.Retrospective, observational case series.We reviewed longitudinal imaging results of 52 highly myopic eyes with dome-shaped macula. Changes on FA and ICGA were assessed. Retinal, choroidal, scleral thicknesses, and bulge height were measured on SD-OCT.Serous RD was the most common abnormality associated with dome-shaped macula, detected by SD-OCT in 44% of the cases with no associated choroidal neovascularization. Significant difference in the proportion of eyes with pinpoint leakage on FA (p<0.001), punctate hypercyanescence on ICGA (p<0.001), and pigment epithelium detachment on SD-OCT (p<0.001) were noted inside the inward bulge of the staphyloma between eyes with and without serous RD. Serous RD was not associated with hyperpermeability areas on ICGA. Eyes with serous RD had thicker choroid (p=0.004), and tended to have thicker sclera (p=0.067) and greater bulge height (p=0.079). Choroidal thickness, scleral thickness, and bulge height were positively correlated (p<0.01). All eyes presented fluctuating course of serous RD during follow-up. Worsening of serous RD was associated with appearance of new punctate hypercyanescent spots on ICGA and leaking points on FA (p<0.001 and p=0.016, respectively).Serous RD in dome-shaped macula was likely caused by choroidal vascular changes, similar to central serous chorioretinopathy, but specifically confined in the inward bulge of the staphyloma and secondary to excessive scleral thickening. Serous retinal detachment showed fluctuating changes overtime, with alternating active and inactive stages. Angiographic findings in dome-shaped macula suggest the choroid as a target for possible treatment strategies.
- Association of open-angle glaucoma loci with incident glaucoma in the Blue Mountains Eye Study. [JOURNAL ARTICLE]
- Am J Ophthalmol 2014 Sep 18.
To determine if open-angle glaucoma (OAG) associated single nucleotide polymorphisms (SNPs) are associated with incident glaucoma and if such genetic information is useful in OAG risk prediction.Case control from within a population based longitudinal study.Study Population: Individuals aged over 49 years of age living in the Blue Mountains region west of Sydney and enrolled in the Blue Mountains Eye Study.Cases for this sub-study (n=67) developed incident OAG between baseline and 10 year visits, in either eye, while controls (n=1919) had no evidence for OAG at any visit. All participants had an ocular examination and DNA genotyped for reported OAG risk SNPs.Incident OAG RESULTS: Two loci also known to be associated with cup:disc ratio as well as OAG (9p21 near CDKN2B-AS1 and SIX1/SIX6) were both significantly associated with incident OAG in the Blue Mountains Eye Study cohort (p=0.006 and 0.004 respectively). The TMCO1 locus was nominally associated (p=0.012), while the CAV1/CAV2 and 8q22 loci were not associated. Multivariate logistic regression and neural network analysis both indicated that the genetic risk factors contributed positively to the predictive models incorporating traditional risk factors.This study shows that previously reported genetic variations related to OAG and cup:disc ratio are associated with the onset of OAG and thus may become useful in risk prediction algorithms designed to target early treatment to those most at risk of developing glaucoma.
- Obituary. David L. Epstein, MD. [Biography, Historical Article, Portraits]
- Am J Ophthalmol 2014 Aug; 158(2):413-4.
- Treatment Outcomes and Spectral-Domain Optical Coherence Tomography Findings of Eyes With Symptomatic Vitreomacular Adhesion Treated With Intravitreal Ocriplasmin. [JOURNAL ARTICLE]
- Am J Ophthalmol 2014 Sep 16.
To determine treatment outcomes of intravitreal ocriplasmin in symptomatic vitreomacular adhesion.Retrospective interventional case series.setting: Private practice. study population: Thirty-five eyes (35 subjects) with symptomatic vitreomacular adhesion. intervention/observation: Intravitreal ocriplasmin injection from February to November 2013. main outcome measure: Vitreomacular adhesion resolution rate. Secondary endpoints included postinjection visual acuity and rates of outer retinal attenuation and full-thickness macular hole (MH) closure.The 35 subjects included were of mean age 69 years, 66% female, and 71% phakic. Eleven subjects (31%) had macular comorbidities. Average adhesion diameter was 571 μm, with mean 7.9 months duration of symptoms. Nine subjects (26%) had epiretinal membrane and 6 (17%) had MH (mean diameter 186 μm). Mean preinjection logarithm of the minimal angle of resolution visual acuity was 0.46, and improved to 0.33 at final follow-up. Fifteen eyes (43%) achieved adhesion release at mean 10 days post injection. One of 6 MH (17%) closed. Transient outer retinal attenuation occurred in 10 of 35 cases (29%), with 8 of 10 (80%) achieving adhesion release. One subject (3%) developed a retinal detachment. Adhesion resolution was more likely in patients with younger age (P = .04), absence of comorbidities (P = .02), small adhesion diameter (P = .005), short adhesion duration (P = .03), and transient outer retinal attenuation (P = .008).Intravitreal ocriplasmin efficacy in the private practice setting, while including patients with macular comorbidities, is similar to that of previous studies. Transient toxicity to the outer retina occurs frequently-typically with adhesion resolution-necessitating careful postinjection spectral-domain optical coherence tomography monitoring.
- Reply. [Letter]
- Am J Ophthalmol 2014 Oct; 158(4):851.